Abstract

Veterans are at higher risk for emergence delirium and emergence agitation due to the high rates of post-traumatic stress disorder (PTSD). Trauma-informed care (TIC) involves recognizing the widespread impact of trauma, the signs and symptoms, and integrating this awareness into all aspects of the patient's care to promote safety and patient empowerment while avoiding re-traumatization. The case presented here generated the following clinical question: In veterans with PTSD undergoing general anesthesia, does a trauma-informed anesthetic approach that includes midazolam, dexmedetomidine, and patient-directed adjustments reduce the incidence of perioperative anxiety and emergence agitation/delirium compared to standard anesthetic practices? The case involved a 55-year-old male presenting for a Nissen fundoplication with hiatal hernia repair. Significant past medical history included post-traumatic stress disorder (PTSD, anxiety, and depression. The patient informed the anesthesia team he is a veteran with diagnosed PTSD and has a recent history of severe emergence delirium (ED). The patient expressed concern for the staff’s safety as the recent diagnostic EGD and colonoscopy induced ED. The facemask and safety straps are triggering components of the perioperative process. The patient voiced that he was extremely anxious in the preoperative area. This led to evaluating the best anesthetic plan for a veteran with PTSD and known ED. The patient was treated for perioperative anxiety and ED using a combination of pre-operative midazolam and dexmedetomidine. The anesthesia team modified the perioperative experience to accommodate specific patient triggers, such as preoxygenation without a facemask. The patient held the circuit during preoxygenation, applied the safety strap until after induction, was extubated on the stretcher, and had family members included in the holding and recovery rooms.

Author Details

Hallie H. Glassco, DNP(c), BSN;  Nancy Westbrook, DNP MSNA CRNA FNP-BC Col (Ret) USAF

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Emergence Delirium, Post-Traumatic Stress Disorder, Veterans, Delirium, Perioperative Care, Anxiety

Advisor

Nancy Westbrook

Second Advisor

Amy Snow

Third Advisor

Terry M. Cahoon

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-30

Full Text of Presentation

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Additional Files

Abstract.pdf (140 kB)

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